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Seven things your radiation oncologist wants you to know

Silhouettes of men's head with connecting linesBY AMBER SMITH

Linda Schicker, MD, an assistant professor of radiation oncology at Upstate, tells what to expect when you face radiation therapy. She sees many of her patients at the Upstate Cancer Center‘s radiation oncology office in Oneida, at 605 Seneca St.

Click here for a podcast/radio interview where Schicker explains what cancer patients should expect from radiation treatments.

1. Our goal is to kill the bad cells and spare the good cells.

 “Radiation is composed of little packets of energy called photons. When those photons interact with matter like the human body, they can either directly or indirectly damage the DNA strands. They don‘t just damage the DNA strands of normal cancer cells. They can also damage the DNA strands of your normal cells.

Linda Schicker, MD

Linda Schicker, MD

“Cancer cells lose their repairability. Sometimes they‘re killed immediately. More often, they will have breaks to that DNA strand, and they can‘t fix it, and after several breaks the cell eventually dies. Depending on where the cell is in the cell cycle, it can be more sensitive to that. Chemotherapy can also make it more sensitive to that kind of damage.

“Regular cells are also damaged that way. But, if we give a minimum of six hours between hits of radiation therapy, normal cells can repair that damage, up to a point.

“So, we can‘t give too much at once, and we can‘t give the treatments too close together, or we would kill the normal cells too.”

2. The ionizing radiation we use is the same that is used for chest X-rays, just stronger.

“Radiation only affects what it hits. If you have a cancer cell on the end of your nose, and I‘m treating your breast, it won‘t do anything for the cancer cell on the end of your nose.

“The radiation travels through you, in a straight line.

It doesn‘t stay in you. It doesn‘t circulate in your body like chemotherapy does.

“External beam radiation is just like getting a chest X-ray. You can‘t feel it, see it or touch the radiation. You won‘t know anything has happened.”

 3. Treatment may also come through radioactive decay.

“Another type of radiation therapy is called brachytherapy. It‘s something you either put inside the body permanently, or that you can put in temporarily with an applicator.

“When we do a radioactive seed implant in a patient with prostate cancer, we put in 80 to 100 very tiny radioactive seeds, smaller than a piece of rice. Those are implanted into the prostate. They stay there permanently. As the seeds are sitting there, they give off radiation by radioactive decay, and eventually they lose their radioactivity.

“For patients who have cervical cancer, we have an applicator that goes into the patient like a hollow tube. Then we have a machine that has a high-dose rate source, such as cesium, that‘s attached to a guide wire that slides into that applicator, where it dwells for a few minutes and then it is removed.”

4. You probably will not lose your hair, and you definitely will not glow.

“Radiation passes through people. It doesn‘t stay in you. So you won‘t be radioactive, and you won‘t glow in the dark.

“Many patients‘ first thought is that they‘re going to lose their hair and they‘re going to be sick to their stomach. That generally doesn‘t happen. If I radiate your head, yes, your hair will fall out. If I radiate your stomach, yes, you will feel nauseated – although we have great medicines now that can help prevent that. Most of the sites that we‘re treating are not the head or the stomach. So you don‘t get the nausea, and you don‘t get the hair falling out.

“Sometimes we see a minimal skin change. It can turn pink, or a little bit tan, or get a little bit of a peel. Often we don‘t see any skin change at all.

“Treatment side effects are site specific. If I treat your throat, you may get a little bit of a sore throat. If I treat your bladder area, your bladder may get a little bit irritable. These tend to be temporary things.”

5. Treatments are usually fast.

 “It only takes a few minutes to do treatments. You‘re usually in and out of the office on a treatment day in about 15 minutes.”

6. You likely will have some decisions to make about your treatment.

“There are often several treatment options, and it‘s important that you be able to understand what they are, so you can make an educated decision. There are short-term and long-term effects to be considered.

“The short-term effects are that generally after about two weeks, sometimes a little sooner, people will notice that they get some fatigue. It won‘t really stop you from doing something you want to go, but you will notice that you‘re a little bit more tired. And, just as it takes a few weeks for that to come on, at the end of treatment it takes a few weeks for that to go away. But it does go away, and you will return to your normal energy level.

“The long-term effects are very important, and we always have to talk about that because it can alter somebody‘s treatment decision. If I tell you ‘if I do this, you may always have a little bit less lung capacity,‘ that‘s an important thing for you to know. Radiation does do damage, and some of that damage is permanent. And sometimes it doesn‘t show up immediately. Sometimes the damage shows up later. So you have to have that conversation.”

7. You can help me help you by eating healthily, exercising and resting.

 “Radiation does damage, and your body will fix that damage, but it needs the building blocks to do it. People who maintain a normal, healthy diet and get enough protein tend to do better. They tend to tolerate treatment better. They tend to heal faster afterward.

“Radiation does make people a little bit tired, but people who get a little bit of exercise every day tend to feel less fatigued. Getting rest is also important. Your body has a job to do. It‘s trying to repair the damage that we do with radiation. Rest helps you do that.”

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.